Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies./ Guía española para el manejo del asma (GEMA) versión 5.1. Aspectos destacados y controversias

Plaza, Vicente; Alobid, Isam; Alvarez, Cesáreo; Blanco, Marina; Ferreira, Jorge; García, Gabriel; Gómez-Outes, Antonio; Gómez, Fernando; Hidalgo, Antonio; Korta, Javier; Molina, Jesús; Pellegrini, Francisco Javier; Pérez, Montserrat; Plaza, Javier; Praena, Manuel; Quirce, Santiago; Sanz, José

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.